TO: _______________________________ ____________________
Certified Personal Trainer Phone Number
________________________________________ has been examined by me
Participant’s Name
and has my approval to participate in a progressive exercise program. I understand the physical and physiological stressors of the program and see no reason why the above named person should not participate.
_______________________________________________________________M.D.
________________________________ _______________________
Physician’s Signature Date
| Fitness Program |
Frequency |
Intensity |
Time |
Type |
| Cardiovascular |
|
|
|
|
| |
|
|
|
| Resistance Training |
|
|
|
|
| |
|
|
|
| |
|
|
|
| Flexibility |
|
|
|
|
| |
|
|
|
| |
|
|
|
| Other |
|
|
|
|
| |
|
|
|
Physician's Recommendations/Contraindications:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
